Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care.

Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.

A Comprehensive Multilevel Analysis of the Bucharest Early Intervention Project: Causal Effects on Recovery From Early Severe Deprivation.

OBJECTIVE: The Bucharest Early Intervention Project is the first randomized controlled trial of foster care as an alternative to institutional care. The authors synthesized data from nearly 20 years of assessments of the trial to determine the overall intervention effect size across time points and developmental domains. The goal was to quantify the overall effect of the foster care intervention on children's outcomes and examine sources of variation in this effect, including domain, age, and sex assigned at birth. METHODS: An intent-to-treat approach was used to examine the causal effects of the randomized controlled trial for 136 children residing in institutions in Bucharest, Romania (baseline age, 6-31 months) who were randomly assigned to either foster care (N=68) or care as usual (N=68). At ages 30, 42, and 54 months and 8, 12, and 16-18 years, children were assessed for IQ, physical growth, brain electrical activity (EEG), and symptoms of five types of psychopathology. RESULTS: Participants provided 7,088 observations across follow-up waves. Children assigned to foster care had better cognitive and physical outcomes and less severe psychopathology than did those who received care as usual. The magnitude of these effect sizes remained stable across development. The foster care intervention most influenced IQ and disorders of attachment/social relatedness. CONCLUSIONS: Young children benefit from placement in families after institutional care. The benefits of foster care for previously institutionalized children were remarkably stable across development.

Structure of Psychopathology in Romanian Preschool-Aged Children in an Epidemiological and a High-Risk Sample.

Objective: Research on bifactor models of psychopathology in early childhood is limited to community samples with little longitudinal follow-up. We examined general and specific forms of psychopathology within 2 independent samples of preschool-aged Romanian children. Within a sample with children exposed to psychosocial deprivation, we also examined antecedents and longitudinal outcomes of the general factor. Method: One sample consisted of 350 Romanian children (mean age = 39.7 months, SD = 10.9) from an epidemiological study; the second sample consisted of 170 Romanian children (mean age = 55.6 months, SD = 1.9) exposed to severe early-life deprivation, as well as community comparison children, with longitudinal follow-up at 8 and 12 years. Psychopathology symptoms were assessed through caregiver-reported structured clinical interviews. Results: An SI-1 bifactor model of psychopathology was supported in both samples and included specific factors for externalizing, internalizing, and disturbed relatedness symptoms. In the second sample, longer duration of psychosocial deprivation and lower-quality caregiving were associated with higher scores on the general and all specific factors. Higher scores on the general factor were associated with later cognitive function, competence, and psychopathology symptoms. Considering all factors together, only the general factor explained variance in later childhood outcomes and was slightly stronger compared to a total symptom count for some, but not all, outcomes. Conclusion: General psychopathology in early childhood explains meaningful variance in child outcomes across multiple domains of functioning in later childhood. However, important questions remain regarding its clinical utility and usefulness, given complex measurement and limited explanatory power beyond the more accessible approach of a total symptom count. Clinical trial registration information: The Bucharest Early Intervention Project; https://clinicaltrials.gov/; NCT00747396.

Foster care leads to sustained cognitive gains following severe early deprivation.

This study examined longitudinal data from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care following exposure to severe psychosocial deprivation. We report data from 135 participants assessed in early adulthood (age 18 y). We find that 16 y after randomization occurred, those who had been randomized to high-quality foster care had significantly higher IQ scores (9 points, 0.6 SD) than those randomized to care as usual. Mediation analyses provide evidence that the causal effect of the intervention on cognitive ability in early adulthood could be explained, in part, by higher-quality caregiving and attachment security. These findings indicate that early investment in family care as an alternative to institutional care leads to sustained gains in cognitive ability. Fostering caregiving relationships is a likely mechanism of the intervention. In addition, exploratory analyses indicate that stable placements throughout childhood are associated with the greatest long-term gains in cognitive ability. Whether early interventions for infants and young children lead to lasting change has significant implications for decisions to invest in programs aimed at improving children's developmental outcomes.

Individual differences in symptoms of maternal depression and associations with parenting behavior.

Links between global levels of maternal depressive symptoms and parenting behavior in early childhood are well established. However, depression is a heterogeneous disorder and little is known about how individual differences in depression symptoms may be differentially associated with different types of parenting behavior. We aimed to uncover nuance in the relationship between depression and parenting behavior by examining individual differences in symptoms of maternal depression and associations with parenting behavior with 2- and 3-year-old children. Participants included 714 diverse, low-income mothers and their 2-year-old children. Maternal depression symptoms were self-reported at child age 2. Three domains of parenting behavior (harsh, positive, and disengaged) were coded from mother-child interactions at ages 2 and 3. Individual differences in maternal depressive symptoms at child age 2 comprised five profiles: low, interpersonal rejection, moderate, high depressed affect and physical, and severe. Women with the high depressed affect and physical profile demonstrated the greatest risk for parenting challenges with higher levels of harsh parenting at child age 2 compared to all other profiles and higher levels of disengaged parenting at child age 3 compared to the low, moderate, and severe profiles. Unexpectedly, positive parenting did not differ by maternal depression profile at either age. There is wide heterogeneity in symptoms of depression among mothers of 2-year-old children that is clinically relevant for different dimensions of parenting. Physical and depressed affect symptoms in particular may present risk for harsh parenting. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Disrupted caregiving behavior as a mediator of the relation between disrupted prenatal maternal representations and toddler social-emotional functioning.

The development of maternal representations of the child during pregnancy guides a mother's thoughts, feelings, and behavior toward her child. The association between prenatal representations, particularly those that are disrupted, and toddler social-emotional functioning is not well understood. The present study examined associations between disrupted prenatal representations and toddler social-emotional functioning and to test disrupted maternal behavior as a mediator of this association. Data were drawn from 109 women from a larger prospective longitudinal study (N=120) of women and their young children. Prenatal disrupted maternal representations were assessed using the Working Model of the Child Interview disrupted coding scheme, while disrupted maternal behavior was coded 12-months postpartum from mother-infant interactions. Mother-reported toddler social-emotional functioning was assessed at ages 12 and 24 months. Disrupted prenatal representations significantly predicted poorer toddler social-emotional functioning at 24 months, controlling for functioning at 12 months. Further, disrupted maternal behavior mediated the relation between disrupted prenatal representations and toddler social-emotional problems. Screening for disrupted representations during pregnancy is needed to facilitate referrals to early intervention and decrease the likelihood of toddler social-emotional problems.

Caregiver regulation: A modifiable target promoting resilience to early adverse experiences.

BACKGROUND: Experiences of adversity in early life are associated with increased risk for negative outcomes; yet, the impact of early adversity on any given child is difficult to predict given the considerable heterogeneity in functioning found even among children with similar exposures. Thus, although early adversity is associated with increased risk for negative outcomes on average, many children are resilient. While researchers have highlighted individual differences in children's internal characteristics that may relate to risk and resilience, external characteristics of the environment that differ between children are mutable factors that are also important for understanding heterogeneity in children's outcomes. OBJECTIVE: We propose that caregiver regulation of children's emotions is a key modifiable feature of the environment that promotes resilience to and recovery from early adversity. Specifically, given the critical role of caregiver regulation of emotions in early life for children's ability to understand and recover from adverse experiences, we highlight three levels of intervention focused on fostering healthy development in young children by targeting the availability, consistency, and quality of caregiver regulation, respectively. RESULTS: We provide a classification system designed to guide decision making about the level of intervention needed to support a given child's needs in terms of ultimately supporting the goal of receiving effective caregiver regulation. IMPLICATIONS: This framework may be useful for guiding the priority of treatments, as well as making clear the needed menu of options to support children following adversity, in addressing specific concerns related to ensuring effective caregiver regulation to promote resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The emotional tone of child descriptions during pregnancy is associated with later parenting.

INTRODUCTION: How parents think and feel about their young children has implications for the parent-child relationship. We examined prospective associations between prenatal descriptions of the unborn child's personality and later parenting behavior. METHODS: Pregnant women (N = 120; mean age = 26.16, SD = 5.71) were recruited in their third trimester for a longitudinal study. The sample is demographically diverse and predominantly economically disadvantaged. During prenatal interviews, women described their unborn child's personality, from which positive and negative emotion words were coded. Parenting behavior was coded 12 months postpartum (n = 105 for longitudinal analyses). RESULTS: Use of positive and negative words was negatively correlated (r = -.34, p < .001). Greater use of positive words to describe the unborn child's personality was associated with higher observed sensitivity, warmth, and engagement during mother-infant interactions, whereas negative words were associated with higher interference and lower levels of sensitivity. Mothers who used anxiety- and/or anger-related words to describe their unborn child, relative to mothers who did not, demonstrated higher interference and lower warmth and sensitivity. CONCLUSION: Descriptions of a child's personality before the child is born were associated with postnatal parenting behavior. Prenatal interventions that address negative thoughts and feelings regarding the child may be beneficial for promoting positive parenting postnatally.

Maternal Psychological Well-Being and Infant Emergency Department Utilization.

BACKGROUND: A mother's psychological well-being impacts her own and her infant's health. Challenges to maternal psychological well-being (eg, depression, anxiety) are associated with increased infant emergency department (ED) utilization. It is not known if other maternal psychological factors, such as relational health and past maltreatment during one's own childhood, are also associated with child ED utilization. OBJECTIVE: Examine maternal psychological factors (ie, childhood maltreatment, mental health, and relational health) associated with infant ED utilization in the first year of life. DESIGN/METHODS: Participants included 120 economically disadvantaged women recruited into a prospective longitudinal study during pregnancy and followed across the first year of their child's life. Mothers reported number of infant ED visits from birth to 1 year (assessed 12-months postpartum), as well as on their own childhood maltreatment, relational health, and mental health (assessed prenatally). Associations between maternal experiences and infant ED utilization were assessed via bivariate correlations and regression analyses. RESULTS: Infants attended on average 0.79 ED visits (range 0-6). Maltreatment during the mother's own childhood, poor relational health, and prenatal mental health symptoms were each associated with greater infant ED visits; maternal age, income, and education were not. In a Poisson regression, childhood sexual abuse was the strongest predictor of infant ED utilization, followed by low acceptance from the mother's father figure and prenatal depression. CONCLUSIONS: Prenatal assessment of psychosocial factors may help identify risk for higher ED use. Women with psychosocial risk factors may need additional support establishing supportive primary and behavioral health care before and after birth.

Early caregiving quality predicts consistency of competent functioning from middle childhood to adolescence following early psychosocial deprivation.

Adverse developmental outcomes for some children following institutional care are well established. Removal from institutional care and placement into families can promote recovery. However, little is known about how positive outcomes are sustained across adolescence among children with histories of severe deprivation. The present study examined the caregiving conditions that are associated with attaining and maintaining competent functioning (i.e., outcomes within typical levels) from middle childhood to adolescence following exposure to early institutional care. The participants included children with and without a history of institutional care who had competence assessed at ages 8, 12, and 16 years across seven domains: family relationships, peer relationships, academic performance, physical health, mental health, substance use (ages 12 and 16 years only), and risk-taking behavior. The participants were grouped based on whether they were always versus not always competent and never versus ever competent at ages 8 through 16 years. Adolescents with a history of institutional care were less likely to be consistently competent than those who were family reared. Among those who were exposed to early institutional rearing, maintaining competent functioning from 8 to 16 years was associated with spending less time in institutions and receiving higher-quality caregiving early in life. Ensuring high quality early caregiving may promote competent functioning following early deprivation.

Prenatal Identification of Risk for Later Disrupted Parenting Behavior Using Latent Profiles of Childhood Maltreatment.

A history of maltreatment during childhood (e.g., physical and sexual abuse, neglect) can threaten the fundamental human need to form and maintain relationships across development, which ensure safety and security. Furthermore, parental maltreatment history presents considerable risk for the emergence of disrupted parenting behaviors (i.e., contradictory communication, sexualized/role-reversed behavior, disorientation, intrusiveness/negativity, and severe withdrawal), which in turn are associated with children's social-emotional development. The purpose of the present study was to examine whether experiences of childhood maltreatment during pregnancy can predict risk for disrupted parenting behavior before the birth of the child. Given the inherent variability in parenting behaviors, we were interested in how different types or combinations of experiences of maltreatment during childhood are associated with later parenting behaviors. Data were drawn from 120 women from a longitudinal study that spanned from the third trimester of pregnancy through 3-year postpartum. In the current study, mothers' experiences of childhood maltreatment were assessed during pregnancy, and disrupted parenting behaviors were coded from videotaped mother-infant interactions 1-year postpartum. Four profiles of childhood maltreatment were identified using latent profile analysis: low exposure, high exposure, high sexual maltreatment, and high physical and emotional maltreatment. Results revealed that high exposure to multiple types of childhood maltreatment most strongly predicted later disrupted parenting behavior. Women with multiple exposures to different types of maltreatment during childhood may require more intense intervention during pregnancy to prevent risk for the development of disrupted parenting behavior.

Adverse caregiving in early life: The trauma and deprivation distinction in young children.

Knowledge and understanding about the impact of cumulative adverse experiences on the health and wellbeing of children, adolescents, and adults has rapidly expanded over the past 30 years. Despite the invaluable attention and support this proliferation has drawn to the importance of early childhood experiences, we believe that it is time to move beyond broad indices of risk and toward more specific and individualized understanding of how risk exposures are linked to clinical outcomes in young children. Within infant and early childhood mental health, there is a need for greater specificity in linking adverse caregiving experiences in early life to psychopathology in children. We highlight a framework distinguishing experiences of trauma from experiences of deprivation and use the examples of posttraumatic stress disorder and reactive attachment disorder to demonstrate how greater specificity in our understanding of early adverse caregiving can lead to more accurate and targeted diagnosis and treatment for young children. Both researchers and clinicians benefit from an approach to gain a greater appreciation of the links between specific types of experiences and outcomes in the children that we serve.

El conocimiento y la comprensión acerca del impacto de experiencias adversas acumuladas sobre la salud y bienestar de los niños, adolescentes y adultos se ha expandido rápidamente durante los pasados 30 años. A pesar de la inestimable atención y apoyo que esta proliferación ha derivado con respecto a la importancia de las experiencias de la temprana niñez, creemos que es tiempo de pasar más allá de los amplios índices de riesgo hacia una comprensión más específica e individualizada de cómo el hecho de estar expuesto a riesgo se conecta con los resultados clínicos en niños pequeños. Dentro el camp de la salud mental infantil, hay una necesidad por mayor especificidad para conectar las adversas experiencias de prestación de cuidado en la temprana parte de la vida con la sicopatología en los niños. Enfatizamos un marco de trabajo que distingue las experiencias de trauma de las experiencias de privaciones y uso de ejemplos del trastorno de estrés postraumático y el trastorno reactivo de la vinculación para demostrar hasta qué punto la especificidad en nuestra comprensión del temprano cuidado adverso puede llevar a un diagnóstico y tratamiento más acertado y dirigido para los niños pequeños. Tanto los investigadores como el personal clínico se benefician de un acercamiento para obtener una mayor apreciación de os lazos entre tipos específicos y resultados en los niños a quienes les servimos.

Les connaissances et la compréhension sur l'impact d'une accumulation d'expériences adverses sur la santé et le bien-être des enfants, des adolescents et des adultes se sont rapidement étendues au fil des 30 dernières années. En dépit de l'attention précieuse et du soutien de cette prolifération qui ont montré l'importance des expériences de la petite enfance, nous pensons qu'il est temps de passer au-delà des indices généraux de risque pour désormais privilégier une compréhension plus spécifique et individualisée de la manière dont les expositions au risqué sont liées aux résultats cliniques chez les jeunes enfants. Au sein de la santé mentale du nourrisson, il est nécessaire d'avoir une plus grande spécificité dans le lien entre les expériences adverses de modes de soin au début de la vie à la psychopathologie chez les enfants. Nous mettons en lumière une structure qui distingue les expériences de trauma d'expériences de privation et utilisons les exemples du trouble de stress posttraumatique et du trouble de l'attachement réactif afin de démontrer la manière dont une plus grande spécificité dans notre compréhension peut mener à un diagnostic et à un traitement plus précis et plus ciblés pour les jeunes enfants. A la fois les chercheurs et les cliniciens bénéficient d'une approche qui nous fait gagner une plus grande appréciation des liens entre les types spécifiques d'expériences et les résultats chez les enfants que nous servons.

Psychosocial deprivation and receptive language ability: a two-sample study.

BACKGROUND: The quality of early caregiving experiences is a known contributor to the quality of the language experiences young children receive. What is unknown is whether, and if so, how psychosocial deprivation early in life is associated with long-lasting receptive language outcomes. METHODS: Two prospective longitudinal studies examining early psychosocial deprivation/neglect in different contexts (i.e., deprivation due to institutional care or deprivation experienced by children residing within US families) and receptive language as assessed via the Peabody Picture Vocabulary Test (PPVT) were used to assess the magnitude of these associations. First, 129 participants from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care in Romania, completed a receptive language assessment at age 18 years. Second, from the USA, 3342 participants from the Fragile Families and Child Wellbeing Study were assessed from infancy until middle childhood. RESULTS: Children exposed to early institutional care, on average, had lower receptive language scores than their never institutionalized counterparts in late adolescence. While randomization to an early foster care intervention had no long-lasting association with PPVT scores, the duration of childhood exposure to institutional care was negatively associated with receptive language. Psychosocial deprivation in US families was also negatively associated with receptive language longitudinally, and this association remained statistically significant even after accounting for measures of socioeconomic status. CONCLUSION: Experiences of psychosocial deprivation may have long-lasting consequences for receptive language ability, extending to age 18 years. Psychosocial deprivation is an important prospective predictor of poorer receptive language. TRIAL REGISTRATION: Bucharest Early Intervention Project ClinicalTrials.gov Identifier: NCT00747396.

Psychiatric outcomes following severe deprivation in early childhood: Follow-up of a randomized controlled trial at age 16.

OBJECTIVE: Early psychosocial deprivation is associated with increased risk for psychopathology, yet few studies have examined outcomes in adolescents. METHOD: At baseline (M age 22 months), 136 children from Bucharest, Romania, living in large institutions, were randomized into foster care (FCG) or to care as usual (CAUG). Caregivers completed psychiatric interviews regarding their children (52 FCG; 51 CAUG) at age 16 years (M = 16.67 years; SD = 0.78) to assess past year diagnoses and symptom counts. In addition, never-institutionalized community comparison children (n = 47) were included. RESULTS: Ever-institutionalized children had higher rates of meeting criteria for any psychiatric disorder and higher symptom counts of internalizing, externalizing, attention-deficit/hyperactivity, and substance use disorders compared to never-institutionalized children (ps < .05). Using intent-to-treat analyses, we found that children in the CAUG had more than twice the rate of psychiatric disorders than children in the FCG (OR = 2.48, 95% CI [1.12, 5.48]). Furthermore, children in foster care who remained in their original placement did not significantly differ in their rates of psychiatric disorders compared to never-institutionalized children. CONCLUSIONS: There are many ways children can be separated from parents, including placement into institutional care. The current findings indicate that such placements are associated with significant risks for psychopathology. Moreover, we provide causal evidence for the long-lasting positive effect of foster care in reducing the risk of psychopathology in adolescence, especially among those in stable placements. These results provide strong evidence that early and stable placements into quality foster care may mitigate risk for psychopathology following severe early psychosocial deprivation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Commentary: Increasing diagnostic precision in reactive attachment disorder - a commentary on Allen & Schuengel (2019).

A study by Allen and Schuengel in this issue of the journal replicates and extends previous findings by Woolgar and Baldock (2015) indicating that community practitioners are far more likely to diagnose reactive attachment disorder in symptomatic children than are specialists using well-validated measures. We consider historic variability in how this disorder is defined but note an emerging consensus in nosologies and among researchers. We consider how more systematic assessments might improve diagnostic efforts to specify the kinds of clinical phenomena that are associated with neglect and deprivation.

Disinhibited Social Engagement Disorder in Early Childhood Predicts Reduced Competence in Early Adolescence.

Psychosocial deprivation is associated with the development of socially aberrant behaviors, including signs of disinhibited social engagement disorder (DSED). In longitudinal studies, signs of DSED have been shown to decrease over time, especially as children are removed from conditions of deprivation. What is less clear is whether signs of DSED in early childhood are associated with poorer functioning in early adolescence, including among children who no longer manifest signs of DSED at this age. In a sample of 136 Romanian children from the Bucharest Early Intervention Project (BEIP), who were exposed to early psychosocial deprivation in the form of institutional care, we examined caregiver-reported (ages 30, 42, and 54 months and 12 years) and observer-rated (age 54 months) signs of DSED. Competent functioning in early adolescence (age 12 years) was assessed across seven domains (i.e., family relationships, peer relationships, academic performance, physical health, mental health, substance use, and risk-taking behavior). A diagnosis of DSED in early childhood was associated with reduced competence in early adolescence. Furthermore, this association was significant even when signs of DSED diminished by age 12 years. We conclude that signs of DSED in early life are associated with reduced likelihood of competent functioning many years later in adolescence, even if signs of the disorder remit.

A prospective longitudinal study of Reactive Attachment Disorder following early institutional care: considering variable- and person-centered approaches.

Although the study of reactive attachment disorder (RAD) in early childhood has received considerable attention, there is emerging interest in RAD that presents in school age children and adolescents. We examined the course of RAD signs from early childhood to early adolescence using both variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. One-hundred twenty-four children with a history of institutional care from the Bucharest Early Intervention Project, a randomized controlled trial of foster care as an alternative to institutional care, as well as 69 community comparison children were included in the study. While foster care was associated with steep reductions in RAD signs across development, person-centered approaches indicated that later age of placement into families and greater percent time in institutional care were each associated with prolonged elevated RAD signs. Findings suggest the course of RAD is variable but substantially influenced by early experiences.

Signs of attachment disorders and social functioning among early adolescents with a history of institutional care.

BACKGROUND: Institutional rearing is associated with increased risk for reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Disorders of attachment involve disturbances in children's primary caregiving relationships, and are likely to disturb multiple domains of social functioning. OBJECTIVE: To examine associations between signs of RAD and DSED and social functioning in early adolescence. PARTICIPANTS AND SETTING: Our participants were 110 children with a history of institutional rearing and 50 community comparison adolescents from the Bucharest Early Intervention Project, based in Bucharest, Romania. Participants were assessed at age 12 years (M age in years = 12.80, SD = 0.71). METHOD: Signs of RAD and DSED were obtained through caregiver report. Reports of social functioning were provided by caregivers and teachers. General and specific domains of social functioning were identified using bi-factor modeling. A general social functioning factor and four specific factors were revealed: peer conflict, caregiver views as victim, teacher views as victim, and social competence. RESULTS: Signs of RAD predicted poorer general social functioning (ß=-0.36, p < .01, 95% confidence interval [CI] [-.33, -.09]) and poorer social competence (ß=-0.38, p < .01, 95% CI[-0.05, -.01]) above and beyond time spent in institutional care and placement disruptions. Signs of DSED (ß=-0.38, p < .001, 95% CI[-0.49, -.16]) along with placement disruptions (ß=-0.22, p < .05, 95% CI[-.29, -.01]) predicted poorer general social functioning above and beyond time spent in institutional care. Signs of DSED predicted higher scores on caregiver views as victim (ß = 0.29, p < .05, 95% CI[0.02, 0.14]) and lower scores on social competence (ß=-0.29, p < .01, 95% CI[-.06, -.01]) above and beyond time spent in institutional care and placement disruptions. CONCLUSIONS: Attachment disorder signs in early adolescence are problematic for social functioning, although the manifestation of these social difficulties differs based on whether RAD or DSED signs are present.

Course of Disinhibited Social Engagement Disorder From Early Childhood to Early Adolescence.

OBJECTIVE: Disinhibited social engagement disorder (DSED) is poorly understood beyond early childhood. The course of DSED signs in a sample of children who experienced severe, early deprivation from early childhood to early adolescence was examined using variable-centered (linear mixed modeling) and person-centered (growth mixture modeling) approaches. METHOD: The study included 124 children with a history of institutional care from a randomized controlled trial of foster care as an alternative to institutional care and 69 community comparison children matched by age and sex. DSED signs were assessed at baseline (mean age 22 months), 30, 42, and 54 months of age, and 8 and 12 years of age using a validated caregiver report of disturbed attachment behavior. RESULTS: Variable-centered analyses based on intent-to-treat groups indicated that signs of DSED decreased sharply for children randomized to foster care and decreased slightly but remained high for children randomized to care as usual. Person-centered analyses showed 4 profiles (i.e., elevated, persistent modest, early decreasing, and minimal). Elevated and persistent modest courses were associated with greater placement disruptions (F3,99 = 4.29, p = .007, partial eta-squared [η2] = 0.12), older age at placement into foster care (F3,56 = 3.41, p < .05, partial η2 = 0.16), and more time in institutional care (F3,115 = 11.91, p < .001, partial η2 = 0.24) compared with decreasing and minimal courses. CONCLUSION: Early and sustained placement into families after deprivation is associated with minimal or decreasing signs of DSED across development. Shortening the amount of time children spend in institutions and preserving placements could help decrease signs of DSED into early adolescence in previously institutionalized children.